Journal of clinical nursing · 2026
Stakeholder Perspectives on Barriers and Facilitators to Implementing Nurse-Led Diabetic Plantar Pressure Assessment and Management: A Multicentre Group Concept Mapping Study.
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Luo Jiayin, Chen Sihan, Qi Xiaojiu, Peng Ke, Zhang Xiaoyan
Аннотация
AIM: To comprehensively identify, conceptualize and map the barriers and facilitators influencing the implementation of nurse-led diabetic plantar pressure assessment and management (NL-DPPAM) from a multicentre, multi-stakeholder perspective and to construct a priority action framework.
BACKGROUND: Despite its critical role in preventing diabetic foot ulcers (DFUs), NL-DPPAM faces a significant evidence-practice gap due to complex barriers and a lack of stakeholder-integrated prioritization frameworks.
METHODS: An exploratory sequential mixed-methods study utilizing multicentre group concept mapping across China engaged 219 key stakeholders. Factors generated via literature, records and brainstorming (QUAL) were sorted and rated for 'Importance' and 'Feasibility' (QUAN). Concept maps were generated using multidimensional scaling and hierarchical cluster analysis. Priority areas were identified using CFIR-based theoretical mapping and Go-Zone plots (INTEGRATION).
RESULTS: The conceptual framework comprises 76 factors across 17 clusters and five CFIR domains, revealing a widespread importance-feasibility gap. Three domains (Implementation Process, Individuals, Inner Setting) and seven clusters (e.g., Planning, Capability, Communications) entered the high-importance/high-feasibility 'Priority Action Zone'. Specifically, 29 factors were prioritized, highlighting critical gaps such as lacking DPPAM operational methods, patient safety prevention plans and standardized outcome evaluation tools.
CONCLUSIONS: This first-of-its-kind multi-stakeholder, data-driven framework systematically delineates the multidimensional determinants of NL-DPPAM implementation. Policymakers should focus on developing strategies targeting areas with both high importance and high feasibility.
BACKGROUND: Despite its critical role in preventing diabetic foot ulcers (DFUs), NL-DPPAM faces a significant evidence-practice gap due to complex barriers and a lack of stakeholder-integrated prioritization frameworks.
METHODS: An exploratory sequential mixed-methods study utilizing multicentre group concept mapping across China engaged 219 key stakeholders. Factors generated via literature, records and brainstorming (QUAL) were sorted and rated for 'Importance' and 'Feasibility' (QUAN). Concept maps were generated using multidimensional scaling and hierarchical cluster analysis. Priority areas were identified using CFIR-based theoretical mapping and Go-Zone plots (INTEGRATION).
RESULTS: The conceptual framework comprises 76 factors across 17 clusters and five CFIR domains, revealing a widespread importance-feasibility gap. Three domains (Implementation Process, Individuals, Inner Setting) and seven clusters (e.g., Planning, Capability, Communications) entered the high-importance/high-feasibility 'Priority Action Zone'. Specifically, 29 factors were prioritized, highlighting critical gaps such as lacking DPPAM operational methods, patient safety prevention plans and standardized outcome evaluation tools.
CONCLUSIONS: This first-of-its-kind multi-stakeholder, data-driven framework systematically delineates the multidimensional determinants of NL-DPPAM implementation. Policymakers should focus on developing strategies targeting areas with both high importance and high feasibility.